New fellowship program aims to reduce LGBT health disparities

On average, about five hours of medical school training are spent covering issues relating to LGBT health, according to a JAMAarticle summarizing the results of a questionnaire to which 132 North American medical school deans responded.

That finding was released in 2011, so perhaps there has been growth in medical school curricula devoted to the particular health needs and concerns of gay, lesbian and transgender Americans in the intervening years. If so, such growth has been slow, say two LGBT physicians, including one who has provided the startup funding to launch an AMA Foundation-sponsored LGBT Fellowship Program to train physicians focused on advancing quality LGBT health care.

Estimates vary, but recent data from the Gallup Organization and researchers at the University of California, Los Angeles School of Law’s Williams Institute indicate that about 5 percent of American adults identify as LGBT.

“There is not a lot of awareness of health disparities that exist in the LGBT patient population,” said Dr. Cohen, even though they have been documented in a number of studies, such as one published in the American Journal of Public Health. He cited pulmonary and heart disease caused by a higher-than-average incidence of tobacco use, as well as alcoholism, suicide, mental health issues, and breast and gynecologic cancers among lesbians as salient concerns facing the LGBT community.

“This lack of awareness extends” to many openly gay and lesbian physicians, he added, who may talk to their LGBT patients about protection against HIV and HPV, but not address other critical issues facing their community. These include social isolation and depression brought on by years of enduring homophobia, living in the closet, and losing friends and loved ones to AIDS in the 1980s and 1990s—issues faced by many older gay men and lesbians.

For all of these reasons, the AMA LGBT Fellowship is a timely and necessary component to medical education, said AMA Board of Trustees member Jesse Ehrenfeld, MD, MPH, co-author of a clinical guide on LGBT health care, who established Vanderbilt University’s LGBTI Program, of which he serves as director. “There is nothing like it today,” said Dr. Ehrenfeld, said of the fellowship program the AMA Foundation is pursuing. “When it is launched, it will fill an important gap for physicians” who need and want comprehensive, up-to-date information about LGBT care.

The AMA Foundation-sponsored, post-residency fellowship will provide $750,000 over a three-year period to MD- and DO-granting educational institutions that create curricula and needed infrastructure to support the training of one physician during each of these years. The hope is that the three physicianswill return to their respective communities armed with advanced training and information and pass along their expertise to other physicians and health professionals about state-of-the-art care tailored for LGBT patients.

“Our goal is to pilot the fellowship at a number of institutions,” which will be invited to submit proposals, said Dr. Cohen, who added that he decided to invest in a fellowship program through the AMA Foundation’s infrastructure because the AMA Foundation has the capacity to bring together physicians and communities to improve the nation’s health.

Over time, Dr. Cohen said, he hoped that a burgeoning of LGBT-related programs at the nation’s medical schools would give way to an accreditation in LGBT health. In addition to Vanderbilt and UCSF, U.S. medical schools with full-fledged curricula in gay, lesbian and transgender health include the Perelman School of Medicine at the University of Pennsylvania and the Icahn School of Medicine at Mount Sinai, said Dr. Ehrenfeld.

Dr. Cohen stressed that the training to become a physician specialist in LGBT care is not reserved to members of the gay, lesbian, bisexual and transgender communities. “I would expect that anyone with an interest in the health needs of the LGBT community” would benefit from the fellowship training opportunity, he said.

The training should help all physicians, irrespective of their sexual orientation or gender identity, because nearly all doctors will treat LGBT patients during their careers, Dr. Ehrenfeld said. Knowledge about clinical issues particular to the LGBT community becomes more critical in those instances when patients either do not come out to their physicians or do not self-identify as LGBT—even after disclosing to their physicians that they have had same-sex experiences.

Patients’ worlds are complex, suggested Dr. Ehrenfeld, and physicians need to be aware of, and appreciate, these complexities to provide the best care possible.

Still in the fundraising phase, the AMA Foundation anticipates it will be able to make its first LGBT Fellowship Program grant to a medical school by 2019. Those interested in making a gift to the program should denote the LGBT Honor Fund as their designation at the AMA Foundation’s website. The foundation’s director of individual giving, Sandi Yandle, is available to answer questions by email or phone, (312) 464-4701.